Area of ileoileal intussusception with large intraluminal hematoma, no necrosis

26Hospital Course

Recovery

PICU

Vitals T98.6 F, Tmax101.2 F, P174/min, R34/min, BP108/51 mm Hg

Hypoactive bowel sounds, surgical site clean, abdomen tender

NG tube at low intermittent suction

Ampicillin 450 mg IV Q 6 hrs (150 mg/kg/day)

Gentamicin 18 mg IV Q 8 hrs (6 mg/kg/day)

Clindamycin 90 mg IV Q 8 hrs (30 mg/kg/day)

Chest X-ray faint air bronchogram visible through the heart

27Hospital CourseCBCSMA 7 28Hospital Course

Day 4

Patient transferred to floor

NG tube removed

Antibiotics discontinued

Day 5

PO diet started

CBC with differential

SMA 7

29Hospital CourseCBCSMA 7 30Hospital Course

Day 5

Tolerated PO intake

Patient discharged

Follow-up

Pediatric surgery

PMD

31Intussusception

Background

Telescoping or prolapse of one portion of bowel into an immediately distal adjoining part

Epidemiology

1-4 per 1000 live births

Age 3 mo 5 yrs

Male-to-female 3-to-1

Mortality/Morbitdity

Mortality with treatment 1-3

Recurrence 3-11

32Pathophysiology

Types

Ileocolic

Colo-colic

Ileo-ileal

Compression of mesentery

Venous engorgement

Edema

Ischemia of intestinal mucosa

Gangrene and perforation

33Causes

Idiopathic

Predisposing factors

Recent upper respiratory illness

Recent diarrheal illness

Intestinal polyps

Intestinal lymphoma

Meckels diverticulum

Henoch-Schonlein purpura

Cystic fibrosis

Hemangioma

34Presentation

History

Sudden onset colicky abdominal pain

Vomiting

Bloody mucous stools

Irritability

Lethargy

Altered mental status

35Physical Exam

Abdomen distended, tender

Abdominal mass

Rectal exam

Occult blood or frankly bloody stools

Laboratory Tests

No laboratory test rules in or rules out the diagnoses of Intussusception reliably

36Diagnostic Imaging

Plain abdominal films

Ultrasound

Target sign

Pseudokidney sign

Doppler flow

Barium/air enema

37Management

Main focus emergent reduction of obstructed bowel

Non surgical reduction

Barium enema

Saline enema

Air enema

Advantages of air enema over barium enema

Easy to administer

Higher success rate

Less radiation exposure

Less dangerous if a perforation occurs

38Management

Contraindications to enemas

Absolute

Clinical signs of peritonitis, perforation, or hypovolemic shock

Relative

Prolonged symptoms ( 24 hrs)

Evidence of obstruction

Ultrasound findings of intestinal ischemia or trapped fluid

39Management

Surgical reduction

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